Hope Lives Where Death Seems to Dwell "East Texas E.M.S." "I need an ambulance!" "O.K., Ma'am, what's the problem?" "A man's been shot! Get here fast!" "Alright, now. Slow a little. What's the location?" In the call received above, practical training was working in unison with academic skills. Normally, this was not an injury in which the victim would survive to speak. Don Elbert had taught me most everything I knew. Before the dispatcher even got off the line, Don and I were already in Unit #6601. We knew the initial direction of the distress call, and we were on our way. The exact location was quickly radioed to us.

When we arrived, we found innumerable lights flashing and what seemed a legion of law enforcement officers. As is not unusual in a violent call such as this, there were no witnesses to the act except the victim. As I approached the victim, it was apparent that this was not a shooting.

myocardial infarction - Myokardinfarkt - scheme

Estimated propability of death or non-fatal myocar...

Death Valley (II)

It was, in actuality, a man lying in the water filled gutter stabbed through the breastbone. He lay on his stomach with his head turned to the right. He had a punctured heart. After perhaps 30 seconds of a field assessment, I saw a man with an extremely light pulse, the slightest of breathing, and a blood pressure of 40/0. The intruding knife used was no larger than a small blade pocketknife, one-quarter inch at its breath. It was similar in size to the knife that my father carried religiously in his pants pocket. The signs I noted in my evaluation, coupled with the knowledge of other signals, pointed to one thing . . . pericardial tamponade.

This type of injury is usually fatal. Already, the man had lain in the street far too long, approximately 30 minutes, without adequate oxygen. I applied a sophisticated piece of equipment to him, Military Anti-Shock Trousers (MAST). This "magic" device, when inflated, pushes a liter of blood from each of the lower three body quadrants to the vital organs: the heart, lungs, and liver. After the administration of the MAST, the man's blood pressure was made to rise to a not so promising 50/0. When we finally got the patient "packaged," I breathed for him with a ventilating mask device while in route to the Trauma Center at East Texas Medical Center.

Another classic sign of this malady, pericardial tamponade, was present. My partner confirmed it. Every time I gave him a breath, the patient lost a palpable pulse due to the extreme pressure within the chest cavity. With the patient not conscious and able to make his own choice, I chose Medical Center because of their expertise and the fact that they were at that time the preferred trauma center in east Texas. This was their specialty, as was it the Emergency Trauma Physician's on duty that night, Doctor Thomas.

After what seemed an eternity, but was in fact only approximately fifteen minutes, we arrived at the emergency room. I continued breathing for the victim even as we were hurrying him into Trauma Room 2. As was customary, the physician relied on the Paramedics for patient history, the treatment given, and our preliminary diagnosis. Upon hearing all that had been done and observed, and seeing that the patient did not have the time to wait for a cardiovascular specialist, Doctor Thomas went to work. He used a four-inch cardiac needle to enter the chest, withdraw the excess fluid from around the heart, and the "magic" took place. The patient's blood pressure elevated to 120/80 (normal). Within a very few days, the man walked out of the hospital, possibly able to see his child, his wife, or perhaps one more sunset.

"IT'S TOO LATE FOR HIM!" "THIS GUY'S LOST! DON'T EVEN WASTE YOUR TIME!" "THERE'S NO USE EVEN TRYING!" "HE'LL BE DEAD BEFORE YOU EVEN GET TO THE HOSPITAL!" What is wrong with these statements? Every one of them is a much too easy way out of a difficult situation. Anyone is able to surrender to circumstances . . . and allow, possibly, another father or mother to die. The question I am forced to ask myself is, "Would I want someone to 'throw in the towel' for me?" My intellect is not superior. It is only a bit more fine tuned with experience and training. Just as "there are no atheists in a foxhole," there are also no heroes in the field of emergency medical services. One does what he needs to do, and what he truly desires to do: help. We are not any more special than the next somebody on the street. What I did that night at around 10:30 P.M. could be done by anyone with certain advanced training.

In the area of my work, I hear unusual things such as "Stat," and "massive MI," and "a flatline." There are always the "DOAs," and the "CVAs," and the "ET tubes." When "stat" is heard, the game rules change from tranquil and relaxed to a rapid responding to the call involving issues such as a complete heart stoppage, or massive myocardial infarction, to a "flatline" of no cardiac or brain activity. The "dead on arrival," could possibly be the result of a cerebrovascular accident, or stoke. There is the inserting of the endotracheal tube to administer oxygen and sustain life a little longer.

I belong to a fraternity of individuals desiring to facilitate wellness. I have kept victims' heartbeats going . . . and I have helped senior ladies calm down a bit by simply reassuring them that they have someone close by. I have supported broken limbs . . . and I have encouraged those experiencing "broken hope." Pericardial Tamponade: fatal? Not necessarily! I always thought it would be lethal if ever I did see it. A conservative estimate would be that ninety to ninety-nine percent of physicians have never even seen it. Oh, they would know what to do if they did see it, but pericardial tamponade is not a common case. It was to my advantage that I was next in line to answer an emergency call.

I have always held that as long as there is a heartbeat, as long as oxygen is getting to the brain, and as long as there is even the slightest smile from "the Man upstairs," there is hope.

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